Effects Of Robotic-assisted Gait Training In Subacute Severe Guillain-barré Syndrome Patients

Background: Guillain-Barré syndrome(GBS)is an acute autoimmune disease of the peripheral nervous system,which may lead to rapidly developing motor deficits,sensory deficits,autonomic dysfunction and respiratory failure.Approximately 20.3% and 18.0% of patients cannot walk unaided at 4 weeks and 6 months of symptom onset.Therefore restoration and improvement of independent walk are one of major goals of GBS rehabilitation.For severely affected neurological patients,gait training using conventional therapy is technically difficult due to their motor weakness and balance problems.Robotic-assisted gait training(RAGT)was developed to overcome these difficulties.RAGT devices have been developed for more than 10 years and there are many studies comparing RAGT with conventional physical therapy in neurological disorders.These study show the effect of RAGT in many neurological diseases,such as stroke,traumatic brain injury,spinal cord injury and multiple sclerosis.According to these studies,the use of RAGT increased the possibility of independent walking;The study aimed to investigate the effects of RAGT treatment on regaining of walking abilities in GBS.The effectiveness of RAGT treatment in GBS is also expected in activity level,gaitcharacteristics,balance,electrophysiological manifestation,sonography of the peripheral nerve and fatigue.Methods:The study was performed between 2014 and 2016 at three centers in Tianjin,China.45 patients were randomly assigned to the RAGT group or control group.For an 8 weeks-periods and 5 times per week,the control group received 60 min physical therapy and 60 min occupational therapy per day.the RAGT group received 30 minutes of the “End Effector” RAGT(LokoHelp),30 minutes of conventional physical therapy and 60 minutes of occupational therapy.Two examiners,who was blinded to the group allocation of study participants,performed all evaluations which include GBS-related demographic and clinical characteristics of participants,GBS disability score(GBS-DS),Medical Research Council Sum Score of Lower Extremity(MRC-SS-L),Berg Balance Scale,Modified Barthel Index Score(MBI),Gait parameters analysis(6-minites walk test),Electrophysiological manifestation,Ultrasonography of the peripheral nerve.Electrophysiological manifestation and Ultrasonography of the peripheral nerve were tested before(T0)and after treatment(T1),other outcome measures were made before(T0),after treatment(T1)and at 6-month follow-up(T2).Result: 1.Effects of RAGT on GBS-DS,MRC-SS-L and BBS GBS-DS,MRC-SS-L and BBS were improved in both RAGT group and control group.Besides,RAGT showed higher score in GBS-DS.2.RAGT improve the gait parameters and overground endurance RAGT significant increased walk speed,cadence and step length compared to the control group,and had statistical significance.But step length of RAGT groups had no statistical significance compared to the control group at 6-month follow-up.3.RAGT promoted the activity of daily living(ADL)The RAGT groups also exhibited a beneficial effect on the activity of daily living,which was higher for RAGT groups compared to the control group after treatment at T1 and T2.4.Effects of RAGT on electrophysiological manifestation We assessed the electrophysiological manifestation at T0 and T1 in both groups.The baseline electrophysiological manifestations,including of the amplitude,distal latencies and conduction velocity,were no difference between the RAGT group and control group.In T1,the amplitudes and conduction velocity were improved and the distal latencies were shorten in RAGT group and control group.While,the three signs of the RAGT group was no statistical differences compared with control group.5.Effects of RAGT on ultrasonography of the peripheral nerve The ultrasonography of the cross-sectional area of tibial nerve and peroneal nerve detection may supports the severity of GBS.After 8 weeks rehabilitation therapy,the cross-sectional area of tibial nerve and peroneal nerve in RAGT group were parallel to these of control group.Conclusion:In the randomized clinical trial,results showed that RAGT reduced disability grade and improved walk speed,stride frequency and step length in subacute GBS patients after 8 weeks treatment.Furthermore,RAGT was found to improve the activity of daily life.These therapeutic effects may be maintained for 6 month post-treatment.However,no significant difference was found in the scores of MRC-SS-lower extremity,balance,electrophysiological manifestation and ultrasonography of the peripheral nerve between the groups after treatment(T1)and at 6-month follow-up(T2).RAGT was found significantly improve the walking abilities in subacute non-ambulatory Guillain–Barré syndrome patients.What is more,RAGT shows better results in some assessments compared to conventional therapy.Its major advantage is the avoidance of the strenuous effort of the therapists during treadmill therapy.In conclusion,RAGT is an effective alternative to conventional therapy in subacute non-ambulatory Guillain–Barré syndrome patient.